Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization

Kim, Edwin; Yang, Luanna; Ye, Ping; Guo, Rishu; Li, Quefeng; Kulis, Michael D.; Burks, A. Wesley

doi:10.1016/j.jaci.2019.07.030

Cited by 110 publications

(87 citation statements)

References 25 publications

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“…suggested improved efficacy with long-term treatment (3-5 years). 129 • Diets containing baked milk or eggs: Mainly for milk and egg allergic patient who can tolerate the baked form of the food (although, some approaches also introduce baked milk in small amounts to baked-milk reactive patients 130 ). It is currently unclear whether consumption of baked food products can accelerate the development of tolerance to unbaked forms of the food (i.e., liquid milk, raw egg).…”

Section: Criteria Data Collected From the Literature Milieu And Consmentioning

confidence: 99%

CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy

Bégin

Chan

Kim

et al. 2020

Allergy Asthma Clin Immunol

139

118

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Background: Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice.Objective: To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods:Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results:The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'A multidisciplinary team comprised of experts from a diversity of fields was assembled, including allergists and other healthcare professional...

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Section: Criteria Data Collected From the Literature Milieu And Consmentioning

confidence: 99%

CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy

Bégin

Chan

Kim

et al. 2020

Allergy Asthma Clin Immunol

139

118

View full text Add to dashboard Cite

show abstract

“…Recently, children with peanut allergy aged 1 to 11 years underwent extended maintenance SLIT with 2 mg/day peanut protein for up to 5 years [37]. Subjects with peanut skin test wheals of less than 5 mm and peanut-specific IgE levels of less than 15 kU/L were allowed to discontinue therapy early.…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

“…SLIT was assessed through a double-blind, placebo-controlled food challenge with up to 5000 mg of peanut protein after completion of SLIT dosing. Results showed that extended-therapy peanut SLIT provided clinically meaningful desensitization in 67% of children with peanut allergy that was balanced with ease of administration and a favourable safety profile [37].…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

Therapeutic perspectives in food allergy

et al. 2020

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Background: In the last twenty years, several studies have been conducted in the search for new therapeutic strategies in patients with food allergy; in particular, after the failure of injection immunotherapy, three different routes of administration, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), have been tested. The aim of this manuscript is to review OIT, SLIT, and EPIT clinical trials on food allergies and to suggest advantages and limits of the different routes of immunotherapy administration. Main body: Of the three different routes of immunotherapy used in the treatment of food allergy, OIT is, at present, the only one actually able to induce an increase in tolerance in the majority of patients. However, its use is affected by serious secondary effects, such as major abdominal symptoms and anaphylaxis. The combination with omalizumab reduces the percentage of serious side effects. There are not many studies with SLIT for food allergy, but they have nevertheless shown that it is possible to obtain an increase in tolerance; however, this increase is modest in comparison with that obtained by OIT. EPIT, performed through the diffusion of allergens on intact skin, is the most recent form of immunotherapy. Although there are many works on EPIT carried out in laboratory animals, only few clinical studies have been published in humans. EPIT, unlike OIT and SLIT, is not responsible for systemic secondary effects such as anaphylaxis and eosinophilic oesophagitis but only for local and mild effects in areas where the devices are applied. Moreover, EPIT is characterized by high patient adherence. Conclusion: OIT seems to have a prevalent application in patients who do not report previous symptoms of systemic or gastroenteric anaphylaxis, while SLIT and EPIT, in particular, could be more preferentially used in patients with a risk of anaphylaxis.

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“…With the discovery of IgE in the 1960s, measurements of IgE have been a first step in diagnosis for atopic diseases. Both allergen-specific IgE (sIgE) and total IgE levels increase during the initial stages of AIT and subsequently decrease, 229 however, decreases may not accompany a positive clinical outcome. 230 Numerous studies indicate IgG1 and IgG4 levels increase with therapy but do not always differentiate between responders and non-responders.…”

Section: Specific Ige and Iggmentioning

confidence: 99%

Biomarkers in the Diagnosis and Therapy of Allergic Diseases and Asthma

Breiteneder¹,

Peng²,

Agache³

et al. 2020

Preprint

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Modern healthcare requires a proactive and individualized response to diseases, combining precision diagnosis and personalized treatment. Accordingly, the approach to patients with allergic diseases encompasses novel developments in the area of personalized medicine, disease phenotyping and endotyping and the development and application of reliable biomarkers. A detailed clinical history and physical examination followed by the detection of IgE immunoreactivity against specific allergens still represents the state of the art. However, nowadays, further emphasis focuses on the optimization of diagnostic and therapeutic standards and a large number of studies have been investigating the biomarkers of allergic diseases, including asthma, atopic dermatitis, allergic rhinitis, food allergy, urticaria and anaphylaxis. Various biomarkers have been developed by omics technologies, some of which lead to a better classification of the distinct phenotypes or endotypes. The introduction of biologicals to clinical practice increases the need for biomarkers for patient selection, prediction of outcomes and monitoring, to allow for an adequate choice of the duration of these costly and long-lasting therapies. Escalating healthcare costs together with questions on the efficacy of the current management of allergic diseases requires further development of a biomarker-driven approach. Here, we review biomarkers in diagnosis and treatment of asthma, atopic dermatitis, allergic rhinitis, viral infections, chronic rhinosinusitis, food allergy, drug hypersensitivity and allergen-immunotherapy with a special emphasis on specific IgE, microbiome and epithelial barrier. In addition, EAACI guidelines on biologicals are discussed within the perspective of biomarkers.

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Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization

Cited by 110 publications

References 25 publications

CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy

CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy

Therapeutic perspectives in food allergy

Biomarkers in the Diagnosis and Therapy of Allergic Diseases and Asthma

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